Clinical InvestigationsMortality and rehospitalization after mitral valve surgery as a function of age and key comorbidities
Graphical abstract
Section snippets
Background
Mitral valve surgery is a complex procedure with significant strain on the patient's cardiac function, hemodynamics, and systemic organ function, which in turn may affect short-term as well as long-term outcomes—although such data are sparsely described. Given that patients with mitral valve disease are often above 60 years of age and comorbid, surgical risk becomes important in the clinical decision making for mitral valve surgery. Less invasive percutaneous therapies such as edge-to-edge
Data sources
This was a retrospective cohort study using Danish nationwide registries and a cardiac surgery database composed of detailed clinical and procedural information from January 1, 2000 to December 31, 2018. All Danish residents are assigned a unique and permanent civil registration number allowing accurate linkage of nationwide administrative registries at an individual level. For this study, data from the following Danish administrative registries were obtained: (1) The Danish National Patient
Baseline characteristics
In the period from January 1, 2000 to December 31, 2018, 4,202 patients (61.9% men) ≥60 years of age underwent mitral valve surgery (ie, valve repair or bioprosthetic/mechanical valve replacement with or with-out other concomitant cardiac surgery) with a median age at time of surgery of 71.2 years (25th-75th percentile 66.2-76.1) (Figure 1). In total, 1,682 (40.0%) patients underwent isolated valve repair, 1,193 (28.4%) underwent valve repair with other concomitant cardiac surgery, 422 (10.0%)
Discussion
In this nationwide study, we examined the 1-year risk of mortality and incident rehospitalization following mitral valve surgery in the period from January 1, 2000 to December 31, 2018. The study yielded the following 4 major findings: first, mitral valve surgery was associated with a high (12%) 1-year risk of postoperative mortality. Second, more than half (59%) of the patients were rehospitalized within 1 year following discharge from mitral valve surgery. Third, factors associated with an
Conclusion
Mitral valve surgery was associated with a high 1-year risk of postoperative mortality. Based on risk factors including age and relevant comorbidities, we could stratify patients in 4 groups estimating the 1-year risk of postoperative mortality. By simple and readily available patient characteristics, we could identify a high-risk population with a 1-year mortality above 25%. More than half of the patients who underwent mitral valve surgery were rehospitalized within 1-year, however, the risk
Conflicts of Interest
Køber serves as a consultant for Boehringer Ingelheim, and has received other support from AstraZeneca, Novartis, and Novo Nordisk. Fosbøl, Havers-Borgersen, Carranza Butt, and Strange reported no financial interests.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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